Well that’s pretty subjective again. At times guys with lower scores have gotten better residency slots than those with higher scores. Still I'll list all the factors that go into determining the probability of getting a residency slot.

1. MLE scores: This is the single most important factor for an IMG at least. The higher the scores the better are the chances. Now there is a confusion over step 1 or 2 scores which are better. General perception is that Step 1 scores are more important. But I'd like to tell you about a study on this factor.

This study concluded that Step 2 scores had higher predictive value for getting good slots than step 1. The predictive value was not affected when step 1 and 2 combined scores were taken into account. This implies Step 2 scores have the maximum predictive value for getting residency, irrespective of step 1 scores. Few people might contradict this but this is what the study says. Here is an extract from that study…

About a month after the completion of the 2004 Residency Match, Kaplan surveyed a set of students who had taken USMLE preparation courses with us over the past year. Students were asked whether or not they had secured a residency position, and for some information about themselves, such as USMLE scores, USMLE failures, the date on which each USMLE Step was passed, the number of programs to which they had applied, their year of graduation from medical school, and whether they were permanent residents of the U.S. or not.

By far, the best predictor of getting a residency position was the USMLE Step 2 score! Good Step 1 scores were also positively related to getting a residency, but STEP 2 scores mattered MORE!

When both Step 1 and Step 2 scores are placed in a stepwise regression analysis to predict the chance of getting into a residency, once Step 2 is entered into the model, there is no predictive capacity left for Step 1. This means that adding a Step 1 score to the model does not give a better prediction. A Step 2 score, by itself, gives the best prediction. Using just Step 2 scores as a predictor, we are able to derive a model that correctly classified 75% of those who did and did not get a residency position.

2. Research: The funda in US is "PUBLISH or PERISH". Research oriented docs are very highly rated. They expect you to be inclined to do research. If you have published research papers, you definitely have an edge. If you don’t have your own papers, any association to any research (like research assistantship) is also plus point cos that shows your interest in research.

3. USCE (US Clinical Experience): This is again a very important factor. Rather many programs shortlist only those candidates who have some USCE. It can be observership (where you only watch docs treating patients, not involved in any way in patient management), externships (You get hands-on experience). Plus if you are targeting a specific program, it’s better to do such externships at that hospital, cos that would increase their chances of taking into their program. But these are tough to get and you need some sort of contacts for that.

4. LORs: These count a lot specially if written by US doc (which is possible only if you do an externship under him). Still a well written Dean's letter and LORs by professor's from your medical school helps.

6. Contacts: well they work everywhere. If you know a big shot in the same university, he might coerce the PD into taking you.

7. Interview itself: Never forget the importance of a good interview. PDs at US want an all round personality.. pleasant, confident, witty with good communication skills. Many guys get a seat over others with higher scores just becos they can have an impact on their PD during interview. General interview rules do apply to residency interviews. Start brushing up your communication skills from today itself.

8. Program selection: There are certain programs termed IMG friendly. If you apply to them, there are higher chances of getting a seat. Plus assessing your own status and factors and being realistic in applying to right programs increases your chances.

9. Co-curricular activities: As I said they just don't want a dumb book worm. I've been told, if your CV contains other stars, like sports and other co-curricular activities, it’s a plus point.

10. Others: Like Teaching experience, some audit experience, previous PG in India, MPH etc. may help you a bit.

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